Tashkandi 1 Tashkandi 10 Does advanced life support (ALS) improve patient outcome? Nezar Tashkandi Creighton university EMSAbstract The research highlights on the use of ALS as an intervention care approach during emergency responses. The predominant use of the approach in the United States further indicates its potential to improve the patient outcomes. The article acmes the use of noninvasive interventions, for instance, endotracheal intubation to improve the outcomes of patients while on the scene before being transported to the hospital. Identifying the services provided by ALS while being compared to other intervention approaches portrays its ability to provide positive patient outcomes. Significantly, the article discusses how the research articles were selected with the help of electronic medical research databases and online Google Scholar engine to identify the vast research conducted in the field of ALS and emergency care. A selection criterion was adopted to facilitate ease in the identification of the informative research articles to be used in the paper. The research article provides a comprehensive discussion of the findings regarding the use of ALS as an intervention to improve the outcomes of the patients. ALS has proven vital to improving the outcomes of patients with multiple injuries and trauma. ALS has been identified as being inferior when dealing with many serious conditions such as cardiac arrest, a finding that depicts its inability to improve patient outcomes. Both the opponents and the proponents highlight their concerns on the use of ALS, a fact that calls for additional research on the intervention approach. Introduction The role of advanced life support amongst pre-hospital patients is a controversial issue that has drawn mixed reactions on its ability to improve the patient’s outcome. Several studies have indicated that the efficiency of out of hospital intervention provided by the paramedics is yet to be clear. The leading emergency response of out of hospital medical treatment provided by ambulance paramedics in the United States is the advanced life support (Sanghavi et al., 2016). Significantly, advanced life support accounts for approximately 65% of emergency medical care amongst the Medicare beneficiaries with the inclusion of patients with high-acuity conditions for instance stroke (Sanghavi et al., 2016). Occasionally, ambulance crews use ALS. Thus they are trained and provided with sophisticated equipment’s that enables them to provide comprehensive care while on site. The looming controversy on the efficiency of this approach is highlighted by the fact that basic life support (BSL) emphasizes on the transportation of the patients to the medical care facilities rather than being treated on site (Sanghavi et al., 2016). Therefore, the BLS treatment crew often provide minim ...

1. Tashkandi 1
Tashkandi 10
Does advanced life support (ALS) improve patient outcome?
Nezar Tashkandi
Creighton university
EMSAbstract
The research highlights on the use of ALS as an intervention
care approach during emergency responses. The predominant
use of the approach in the United States further indicates its
potential to improve the patient outcomes. The article acmes the
use of noninvasive interventions, for instance, endotracheal
intubation to improve the outcomes of patients while on the
scene before being transported to the hospital. Identifying the
services provided by ALS while being compared to other
intervention approaches portrays its ability to provide positive
patient outcomes. Significantly, the article discusses how the
research articles were selected with the help of electronic
medical research databases and online Google Scholar engine to
identify the vast research conducted in the field of ALS and
emergency care. A selection criterion was adopted to facilitate

2. ease in the identification of the informative research articles to
be used in the paper. The research article provides a
comprehensive discussion of the findings regarding the use of
ALS as an intervention to improve the outcomes of the patients.
ALS has proven vital to improving the outcomes of patients
with multiple injuries and trauma. ALS has been identified as
being inferior when dealing with many serious conditions such
as cardiac arrest, a finding that depicts its inability to improve
patient outcomes. Both the opponents and the proponents
highlight their concerns on the use of ALS, a fact that calls for
additional research on the intervention approach. Introduction
The role of advanced life support amongst pre-hospital patients
is a controversial issue that has drawn mixed reactions on its
ability to improve the patient’s outcome. Several studies have
indicated that the efficiency of out of hospital intervention
provided by the paramedics is yet to be clear. The leading
emergency response of out of hospital medical treatment
provided by ambulance paramedics in the United States is the
advanced life support (Sanghavi et al., 2016). Significantly,
advanced life support accounts for approximately 65% of
emergency medical care amongst the Medicare beneficiaries
with the inclusion of patients with high-acuity conditions for
instance stroke (Sanghavi et al., 2016). Occasionally,
ambulance crews use ALS. Thus they are trained and provided
with sophisticated equipment’s that enables them to provide
comprehensive care while on site. The looming controversy on
the efficiency of this approach is highlighted by the fact that
basic life support (BSL) emphasizes on the transportation of the
patients to the medical care facilities rather than being treated
on site (Sanghavi et al., 2016). Therefore, the BLS treatment
crew often provide minimal treatment while on scene whereby
the primary objective is to rush the patient to the hospital, an
approach that is often referred to as “scoop and runs”. Often,
the ALS providers deployed the use of noninvasive
interventions, for instance, endotracheal intubation to facilitate

3. airway management and intravenous catheters for fluid delivery.
The services provided by the ALS paramedics require them to
spend more time at the scene that is translated to an average of
5-7 minutes (Sanghavi et al., 2016). Despite the existing
predominance of ALS treatment in the United States, several
studies conducted in other countries have highlighted
significant aspects that do not support its value. Primarily, the
studies pinpoint that BLS is associated with a longer survival or
positive patient outcomes compared to ALS. This fact portrays
the presumption that ALS treatment approach is not related to
positive patient outcomes. However, the benefits of ALS
intervention cannot be sidelined including dextrose and
thrombolytics. Additionally, studies have indicated that there
exist no differences in outcome when BLS and ALS are used to
intervene myocardial infarction. Despite this, both the
proponent and the opponents of advanced life support call for
additional research to ascertain the particular interventions that
might be deemed probable for using ALSMethods
The electronic medical research databases that are available
through Grand Canyon University, University of Maryland-
Baltimore County and Tulane University School of Medicine
libraries were searched. These databases comprise of MD
Consult, Lexis-Nexus, and PubMed. Additional research was
conducted through the Google Scholar online platform whereby
peer-reviewed journals were identified with other websites that
had resourceful information relating to the use of advanced life
support as an intervention approach outside the hospital. Both
the databases and Google Scholar were searched with the use of
a combination of terms including “advanced life support,”
“emergency medical services,” “advanced cardiac life support,”
“thrombolytic therapy,” “emergency treatment,” “out of hospital
medical treatment” and “basic life support.” Significantly, the
research included articles that were published after 2000.

4. The systematic review was mainly focused on patient’s
secondary survival whereby the studies allowed incorporated a
follow-up of the patient until his/her discharge from the
healthcare facility. The research considered that studies which
use survival until arrival at the healthcare facility were
sensitive to the distance and the transport system that was used.
Therefore, the study did not include studies that focused on
treatment delays. Additionally, the articles whose foundation
were based on the geographical epidemiology were not used for
research.
Articles identified in the research process were excluded for a
number of reasons including; BLS response was discussed as
the intervention approach that is used in out of hospital
treatment, the article was written in a different langue rather
than English, it was identified as an aeromedical response and
an emergency medical technician was included to be part of the
ALS response. The eight articles that met the inclusion criteria
of the research were included in the reference section. The main
findings of each article were discussed to provide a broader
scope on the significance of the topic.
Discussion
According to Callaham, 2014, patients with cardiac arrest
outside the hospital portrayed less survival to hospital discharge
if they receive advanced life support from the ambulance
personnel (Shuster, Keller and Shannon, 2004). According to
the study, the survival rate of patients who received ALS was
approximately 9.2% which was lower compared to patients that
received BLS which stood at an estimate of 13.2% (Callaham,
2014). The findings of the research study indicate the fact that
ALS is not associated with greater patient outcomes when used
during emergency situations. The less significance posed by
ALS as a response can be based on the fact that its efficiency is
much lower when responding to emergency issues that are of
importance (Sanghavi et al., 2016).

5. The sophisticated methods used by the paramedics and the
ambulance personnel are less efficient thus the main reason
behind its inability to improve patient outcome significantly.
Callaham, 2014 shares the perspective that, despite the vast
amount of resources reserved for the use of ALS, the high
mortality rates is an indication of its inefficiency. The ALS
provides a fundamental component of the response during
emergency situations. However, its inability to provide
improved positive outcome is an indication of its shortcomings.
Mostly, ALS has been associated with much less positive
outcomes when dealing with sophisticated conditions such as
cardiac arrest, an aspect that might be linked to the training
capacity of the ambulance personnel and the paramedics who
offer services at the emergency scenes (Callaham, 2014). The
study has called into question the widespread perception that
advanced life support has provided positive patient outcomes
amongst out of hospital cardiac arrest patients through its
interventions. The new finding calls for evaluation of the use of
ALS in other diagnosis groups to ascertain its capacity to
provide positive patient outcomes. Notably, the clinical
mechanisms associated with advanced life support should be
assessed. This facet facilitates the identification of out of
hospital care strategies that can be adopted to ensure that ALS
not only saves a life but also improves the quality of services
offered to patients in different diagnosis groups.
Research conducted amongst trauma patients has indicated
various benefits regarding the use of ALS as an intervention
during emergency responses (Liberman and Roudsari, 2007).
According to Isenberg & Bissell, 2005, patients with trauma
who receive ALS care on the scene show a significant
improvement on the trauma scores. During the study, no
mortality cases amongst the patients who received ALS care
was reported. Primarily, the study highlighted the fact that
trauma patients who received ALS care portrayed a lower

6. mortality rate within the first 24 hours, an aspect that further
indicates the efficiency of using ALS as an intervention
approach during emergency situations (Eckstein et al., 2000).
Notably, ALS has significant reduction of pulmonary failure
amongst the trauma patients. The research findings is an
indication that the provision of ALS during emergency response
is associated with lower mortality rates and increased injury
scores (Liberman and Roudsari, 2007).
The research by Isenberg & Bissell, 2005, is an indication that
ALS is associated with improved trauma scores based on the
fact that patients are provided with sophisticated care on the
scene. The ambulance personnel’s and the paramedics are
equipped with sufficient training and equipment’s that
continually enhance their ability to provide advanced care
amongst the trauma patients thus reduce the mortality rates
significantly (Eckstein et al., 2000). Despite this, the trauma
patients who received ALS treatment showed no reduction in
the length of stay within the intensive care unit. Additionally,
opponents of the findings share the perception that the study
was focused on blunt trauma while sidelining penetrating
trauma. According to research, ALS is associated with positive
patient outcome amongst blunt trauma patients. However, the
results are not the same amongst penetrated trauma patients as it
decreased the survival of the victims. However, this new finding
is sidelined by the fact that statistics from motor vehicle crashes
indicate the fact that patients who received ALS illustrated an
increased improvement in blood pressure and trauma scores
(Eckstein et al., 2000). The findings by the researchers portray
the need for additional research to identify the actual outcomes
of trauma patients who received ALS care. Despite the fact that
ALS is associated with positive care amongst blunt trauma
patients, its efficiency on penetrated trauma patients is still a
controversial issue that calls for additional research. The
findings by Isenberg & Bissell, 2005, indicate the fact that ALS
is associated with positive outcome amongst trauma patients by

7. improving its scores.
Studies that concern unselected patient groups have highlight
ALS a being an inferior treatment intervention approach
(Ryynänen et al., 2010). Studies that cover the efficiency of
ALS on all injuries further indicates that ALS is less superior
when compared to BLS. Notably, the treatment offered by ALS
paramedics and ambulance personnel has been identified das
being harmful due to the lack of an experienced personnel
(Jayaraman and Sethi, 2010). However, when the patient
material is concentrated to an array of severe cases, ALS is
associated with some beneficial aspects due to the services
offered on the scene (Ryynänen et al., 2010). For example,
studies indicate that patients with multiple injuries benefit
highly from ALS intervention. This aspect is based on the
perception that both the paramedics and the ambulance
personnel can provide comprehensive care to the patient while
on the scene such as stopping of excessive bleeding after car
crashes thus providing the patient with a better chance of
survival. This finding is an indication that ALS is associated
with positive patient outcomes. However, not all studies
confirm to this conclusion with some highlighting the need of
an experienced physician to support the provision of the
required services (Ryynänen et al., 2010). Mainly, the
opponents of ALS highlight the fact that the delivery of care
while at the site by the paramedics can be harmful due to their
limited experience thus might result in adverse patient
outcomes. Despite the concern on the lack of an experienced
physician, no studies have indicated the existence of positive
patient outcomes in the events that an experienced personnel
was present when providing ALS care (Jayaraman and Sethi,
2010). This indicates significant shortcomings in the study of
the effectiveness of ALS care when compared to other
intervention approaches (Ryynänen et al., 2010).
ALS intervention care has portrayed positive patient outcomes

8. amongst trauma patients, an aspect that indicates its ability to
provide positive patient outcomes. Notably, patients with
multiple injuries fare well with ALS intervention as it is
associated with improved scores. However, an overall
perspective that concerns unselected patient groups illustrates
ALS as being an inferior intervention during emergency
response. Mostly, the huge chunks of resources vested in the
intervention approach should enhance its ability to improve
patient outcomes. The approach is linked with insignificant
patient outcomes, especially when dealing with serious
conditions such as cardiac arrest (Shuster, Keller and Shannon,
2004). The finding on its inability to provide positive patient
outcomes amongst cardiac arrest and penetrated trauma patients
is a further indication of its inefficiency. Despite the fact that
additional research is still needed in the field, ALS is an
inferior intervention approach when compared to other care
delivery services. This intuition is associated with the lack of
an experienced personnel within the team that provides
intervention care on the scene.
Conclusion
ALS intervention is undoubtedly the predominant response that
is used in emergency situations. Despite this, the efficiency of
the approach is still questioned based on its inability to provide
positive patient outcomes in different patient groups. ALS care
professions such as the paramedics provide sophisticated care
on the scene before transporting the patient to the hospital. This
approach has resulted in a massive amount of resources being
channeled into the approach on the presumption that it enhances
the positive outcome of the patient. However, studies have
indicated that the fact that ALS is superior compared to other
intervention approaches such as BLS when dealing with specific
patient groups. Despite this, limited research on its inefficiency
is a point of concern whereby some researchers differ on its
capacity to provide positive patient outcomes amongst the
trauma patients (Eckstein et al., 2000). This calls for additional

9. research on the use of ALS as an intervention approach during
emergency responses.References
Callaham, M. (2014). Basic vs. Advanced Life Support
Outcomes after Out-of-Hospital Cardiac
Arrest - For the Media - JAMA Network.
Media.jamanetwork.com. Retrieved 20 April
2017, from http://media.jamanetwork.com/news-item/basic-vs-
advanced-life-support-
outcomes-after-out-of-hospital-cardiac-arrest/
Eckstein, M., Chan, L., Schneir, A., & Palmer, R. (2000). Effect
of Pre-hospital Advanced Life
Support on Outcomes of Major Trauma Patients. The Journal of
Trauma: Injury,
Infection, and Critical Care, 48(4), 643-648.
http://dx.doi.org/10.1097/00005373-
200004000-00010
Isenberg, D., & Bissell, R. (2005). Does Advanced Life Support
Provide Benefits to Patients? A
Literature Review. Pre-hospital and Disaster Medicine, 20(04),
265-270.
http://dx.doi.org/10.1017/s1049023x0000265x
Jayaraman, S., & Sethi, D. (2010). Advanced trauma life
support training for ambulance crews.
Cochrane Database of Systematic Reviews.
http://dx.doi.org/10.1002/14651858.cd003109.pub2
Liberman, M., & Roudsari, B. (2007). Pre-hospital trauma care:
what do we really know?
Current Opinion in Critical Care, 13(6), 691-696.
http://dx.doi.org/10.1097/mcc.0b013e3282f1e77e
Ryynänen, O., Iirola, T., Reitala, J., Pälve, H., & Malmivaara,
A. (2010). Is advanced life
support better than basic life support in pre-hospital care? A
systematic review.
Scandinavian Journal of Trauma, Resuscitation and Emergency

10. Medicine, 18(1), 62.
http://dx.doi.org/10.1186/1757-7241-18-62
Sanghavi, P., Jena, A., Newhouse, J., & Zaslavsky, A. (2016).
Outcomes of Basic versus
Advanced Life Support for Out-of-Hospital Medical
Emergencies. Annals of Internal
Medicine, 165(1), 69. http://dx.doi.org/10.7326/l15-0628
Shuster, M., Keller, J., & Shannon, H. (2004). Effects of Pre-
hospital Care on Outcome in
Patients with Cardiac Illness. Annals of Emergency Medicine,
26(2), 138-145.
http://dx.doi.org/10.1016/s0196-0644(95)70143-5
Emergency Medical Services Education
Paramedic Education Program – Research Project
March 13, 2017 – P120
Assignment – You are to pick a topic of your choice relating to
the field of emergency medical services. This topic must be
submitted to the designated instructor for approval, by email.
Duplication of topics will not be allowed; a student who first
submits a particular topic, will own it. Once you have been
given approval, you will thoroughly research the topic, which
will require effort on your part. You should plan on visiting an
academic library (electronically if you wish) to consult multiple
references on your chosen topic. Sources of information may
include journals, textbooks, Internet information (must be
scholarly or government sites; no wikipedia), research
documents, personal interviews (experts), or other appropriate
reference material.
Purpose – This assignment is meant to be an opportunity for you
to look closely at an issue that interests you and that you would
like to learn more about. Nearly all subjects, even clinical

11. topics will often involve some type of controversy. You are to
present all sides (pro and con) and weigh in with your opinion.
Your opinion, however, must be supported by facts. As part of
our goal to make you responsible professionals who are able to
think critically and guide our profession in the future, we feel
that this is an important project for you to complete. Failure to
complete this assignment satisfactorily will result in failure of
the program due to incomplete coursework.
Possible Topics:
My Topic is
Does Advance life support (ALS) improve patient outcome?
I am a paramedic student and this paper should give my opinion
on how works goes for ambulance and being a paramedic not an
EMT
Please let me know back if you have more question, Ntashkan
What you do after you have selected an approved topic and have
done your research:
You will need to prepare a research paper that includes a
minimum of 6-pages, 10-12-pt font, 1-inch margins, that is
typed and double-spaced. Please limit your papers to no more
than 10-pages. Included in your paper is to be a cover page and
a bibliography of your sources (pages not included in
minimum). APA is the preferred method for citations (APA, 6th
edition). Your paper should be organized by the following large
sections: Abstract, Introduction, Methods, Discussion, and
Conclusion. In addition to content, format, logical organization
of ideas, grammar and spelling counts.